Eyes on the Prize: Why timing matters when gaining optometry credentials

Many patients have put off non-critical medical appointments in recent months as the unknowns of the COVID-19 pandemic kept us at home. For optometrists, this means routine eye exams and contact lens prescriptions were put on hold. But the time will soon come when these important visits will need to take place. With contacts running low and expired exams, patients will soon become desperate to get their refills.

While that may sound great for the physician, it’s important to understand what makes optometry different than, let’s say, a podiatrist or pediatrician. Physicians provide medical services, as do optometrists, but it gets complicated when you add in “accessories” that often accompany medical visits. Durable medical equipment, or DME, consists of the lenses and other items that supplement a prescription. What do professionals need to do to properly prescribe these pieces? The tricky part for optometry professionals comes into play when coding claims, and even before the visit occurs, when credentials need to be gained.

Getting credentialed is not as easy as you think. Optometrists need to be credentialed twice, essentially. This means they must gain credentials to provide the medical portion of a visit, but also need be properly credentialed to administer DME. Gaining DME credentials can be more involved and may even require on-site visits to ensure the office’s premises are fit to offer these services. There’s also the need to be credentialed with different payers. It’s safe to say that lots of moving parts need to be in place in order to be approved. A practice needs to be open and operating and there are background checks and fingerprinting, among other things. One thing is for sure: timing is critical.

Once an optometry practice is opened, or a new practitioner is brought on staff, applications must be submitted ASAP. Let’s say a new provider performs a service that involves a recommendation for DME, then the biller starts the claim submission process. Maybe she doesn’t realize they are not properly credentialed for DME, and the claim is denied by the payer. Well that results in potential lost revenue, certain headaches, and now she has to start the credentialing process all over. With dollars on the line, it’s critical to know where you stand with the payers.

DME credentialing is complicated to say the least, which is why some vision providers forget to apply for this segment of the process, or put it off. The saying “out of sight, out of mind” is not the best stance in this instance. With upticks in appointments and lens prescriptions, providers need to get ahead of denials and ensure their credentials are valid and up to date. To do so, it’s important to work with a partner that knows what they’re doing. Practices need experts that know payer requirements and can get the job done right the first time.

Are you an optometrist wanting to provide both medical and DME services? It’s time to get a clear 20/20 view of your practice’s needs. Gain the necessary insight to see how TPS can help your practice with its credentialing needs by clicking here.